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Grievance Management

Grievance Management

CARF® standards requires that a grievance and appeals process is established for personnel and persons served.  A grievance is defined as a perceived cause for complaint. In addition to CARF® standards, certain entities participating in Medicare and Medicaid are required to have specific grievance policies and procedures, which may include timeframes for resolutions. An organization may need to meet specific grievance resolution expectations by state licensing or other agencies. Policies and procedures must be written for both, persons served and personnel.  Templates are located on the Accreditation Now website in Documents, Group One: Aspire to Excellence, I. Human Resources and K. Rights of Persons Served.

Verbal Complaints

An informal personnel grievance is identified as a verbal complaint to a supervisor or member of management.  An informal client grievance can be identified as a verbal complaint to any personnel employed by the service provider.  It is advantageous to resolve conflicts at the informal level, when possible.  For this reason, it is important that conflict resolution techniques be included in your training program, for all personnel.

Written Grievance

A formal grievance is a written complaint that is presented to management, internally. It is advantageous to resolve an internal complaint to avoid external reporting which may result in undesired consequences.

External Actions

There are a number of external entities that a client or personnel may turn to for relief, should a conflict remain unresolved.  Accrediting bodies, licensing departments and the court system are just a few of the external options available.  External options, by the complainant, should be viewed as a last resort.

Grievance System

The grievance system should provide personnel and persons served with a safe means of internal conflict resolution. Individuals should be encouraged to file grievances in-house prior to exploring outside options.

Upon orientation, persons served are to be educated on their rights to file a grievance. They should understand that filing a grievance will not compromise their level of care or confidentiality.  They should be instructed in the procedures to follow in filing the grievance and appeals process. Persons served should be provided a handout detailing the procedures.

Upon hire, personnel are instructed in the grievance policies and procedures for both staff and persons served. This instruction will include the appeals process.  Personnel should understand that grievances are tracked by the organization for quality improvement purposes. Policies and procedures should be available in the personnel manual, available to all personnel.

Grievance Types

Categorizing types of grievances helps direct the complaint to the most appropriate person, or department, for investigation.  Categories help to assist in identifying causes and trends.  This identification can be used to assess areas for performance improvement.

Common Categories:

  • Alleged Criminal Behavior by Staff
  • Alleged Criminal Behavior by Client
  • Alleged Illegal Discrimination
  • Alleged Misconduct by Staff
  • Alleged Misconduct by Client
  • Alleged Sexual Harassment
  • Alleged Workplace Harassment
  • Alleged Wrongful Disciplinary Action
  • Alleged Breach of Confidentiality
  • Alleged Abuse
  • Alleged Neglect

Grievance Investigation

Specific individuals or commissions will be identified to investigate all grievances.  Individuals with investigative authority should receive additional training specific to personnel and/or client grievances.  Additional training might include labor laws, client rights regulations, investigative techniques, etc.  Investigation protocols would include interviewing the complainant, witnesses and others with potential knowledge of the issue.  The investigator will identify any steps that have already been taken towards resolution.  Research may be necessary in laws, regulations, policies, procedures, and patient records.  The investigator(s) will provide written documentation of the investigative procedures used.

A determination will be made to the validity of the grievance.  A variety of terms may be used to identify the validity of a complaint. If the investigator determines that the complaint is true or substantiated, the investigator will label the grievance as substantiated, valid or founded.  If the investigator determines that the complaint is untrue or unsubstantiated, the grievance will be labeled as unsubstantiated, invalid or unfounded.  Some investigations may not reveal whether or not the claim is true. When this is the case, the grievance will be labeled undetermined.

Resolution procedures may require review by legal counsel, risk management and/or quality assurance. Outside authorities may need to be notified. A response to the complainant is required.  Should the complainant disagree with the results of the investigation, they have a right to an appeals process, which should be clearly outlined in the procedures.

Quality Improvement

By collecting data on grievances in an electronic database, organizations are able to categorize and analyze causes and trends. Quality improvement leads to a more harmonious work environment, greater patient/client satisfaction and reduced liabilities.  Schedule a web demonstration on utilizing the Accreditation Now Grievance Systems, for both, personnel and persons served.


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